Consumer Protections and Rural Health Care: Two More Reasons to Oppose the Express Scripts-Medco Pharmacy Merger

Six leading consumer groups and a leading non-profit independent antitrust think tank have renewed their opposition to the proposed mega-merger of pharmacy benefit managers (PBMs) Express Scripts and Medco. In addition, a Minnesota Congressman is concerned that the deal could harm rural communities and health care.

The American Antitrust Institute, Consumer Federation of America, Community Catalyst, U.S. Public Interest Research Group (PIRG), National Consumers League and National Legislative Association to Reduce Prescription Drug Prices (NLARx) are raising additional arguments in their opposition to the merger. In a Jan. 10thletter to Federal Trade Commission (FTC) Chairman Jon Leibowitz, the groups say patients should not be forced to rely solely on health insurance plans to safeguard against potential anticompetitive conduct and questionable practices by PBMs.

“Our message is plain: health plans are inadequate representatives of the interests of the ultimate consumer,” they wrote.

Citing the over $370 million paid by PBMs in recent years to settle allegations of fraud and deceptive practices, the groups assert that, “PBMs have repeatedly acted in opposition to the interests of consumers and yet, the health plans have played no role in this effort to protect consumers. That is why government enforcement action was necessary in those cases and is needed here.”

Moreover, the groups noted, should the merger go through, the ability of health plans to represent consumers’ interests would be further diminished in the face of the clout wielded by such a mega-PBM who could retaliate against health plans.

U.S. Rep. Tim Walz (D-Minn.) also wrote to Chairman Leibowitz to express his concern this week, citing the contributions of community pharmacists to rural communities and medical care.

“In Minnesota, community pharmacies are extremely important patient resources and support the local economy of rural areas,” he wrote. “I am concerned the Express Scripts-Medco merger could force many small pharmacies to go out of business, leaving a void of services in many rural communities.”

“This merger has the potential to negatively impact patients, consumer choice and local economies,” he concluded.

NCPA continues to oppose the proposed merger due to its potential to reduce competition, undermine patient access and increase prescription drug costs.